Munro N P, Thomas P J, Deutsch G P, Hodson N J
Department of Urology, Royal Sussex County Hospital, Brighton, UK.
Ann R Coll Surg Engl. 2001 May;83(3):180-5.
Aspects of the management of penile cancer remain controversial. In the management of early T1 N0 disease, treatments are divided between amputation and a variety of penis conserving techniques (PCT); local excision, laser techniques, chemotherapy and radiotherapy. We report on a retrospective series of patients with penile cancer.
Thirty-seven patients were diagnosed between 1987-1996. All patients records were retrieved. Data recorded included TNM stage, histological grade and treatment. The end-points were death, nodal progression and local recurrence.
Median survivor follow-up of 42 months was obtained. Twenty-six patients (70%) presented with T1 disease, 7 (19%) T2 and 4 (11%) T3 or T4. Inguinal nodal disease was seen in 11 (30%). The mean age was 63 years. Overall, 13 penile amputations were performed, 13 underwent radiotherapy, 6 were locally excised in combination with radiotherapy and 3 underwent local excision alone. Two patients were unsuitable for treatment. Of the total (37 patients) 15 have died; 12 from penile cancer. Ten have suffered disease progression and 12 remain alive with no evidence of disease. Twenty-three patients presented with early T1 NO disease. They were treated with radiotherapy (12), local excision (2), combined radiotherapy and excision (2) and partial amputation (4). Outcome was not significantly related to treatment modality. Spread to the inguinal nodes or local recurrence has occurred in 10, of whom 2 have died. Only 13 (57%) appear disease-free.
The characteristics of the patients and the disease in this series are similar to published series in Europe and North America. There is significant variability in the modalities of treatment used within this series. Local recurrence and disease progression occurs in 43% of T1 N0 lesions. There would seem to be some room for improvement. International data are retrospective and inconclusive with regard to best practice. There is an urgent requirement for randomised controlled trials to improve the outcome of these patients.
阴茎癌的管理方面仍存在争议。在早期T1 N0疾病的管理中，治疗方法分为截肢和多种保留阴茎技术（PCT）；局部切除、激光技术、化疗和放疗。我们报告了一组阴茎癌患者的回顾性研究。
1987年至1996年间诊断出37例患者。检索了所有患者的记录。记录的数据包括TNM分期、组织学分级和治疗情况。终点指标为死亡、淋巴结进展和局部复发。
获得了42个月的中位生存期随访。26例（70%）患者为T1期疾病，7例（19%）为T2期，4例（11%）为T3或T4期。11例（30%）出现腹股沟淋巴结疾病。平均年龄为63岁。总体而言，进行了13例阴茎截肢手术，13例接受了放疗，6例在局部切除的同时结合放疗，3例仅接受了局部切除。2例患者不适合治疗。在全部37例患者中，15例死亡；12例死于阴茎癌。10例出现疾病进展，12例存活且无疾病证据。23例患者表现为早期T1 N0疾病。他们接受了放疗（12例）、局部切除（2例）、放疗联合切除（2例）和部分截肢（4例）。结果与治疗方式无显著相关性。10例出现腹股沟淋巴结转移或局部复发，其中2例死亡。只有13例（57%）似乎无疾病。
本系列患者和疾病的特征与欧洲和北美的已发表系列相似。本系列中使用的治疗方式存在显著差异。43%的T1 N0病变出现局部复发和疾病进展。似乎仍有一些改进空间。关于最佳实践，国际数据是回顾性的且无定论。迫切需要进行随机对照试验以改善这些患者的治疗结果。
